Select Committee on Quality Improvement in State Hospitals Hospital...
Transcript of Select Committee on Quality Improvement in State Hospitals Hospital...
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 1
Select Committee on QualityImprovement in State HospitalsPERIODIC REPORTING
Alice Huber, PhDFacilities, Finance, and Analytics Administration Research and Data Analysis [email protected]
October 18, 2018
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 2
Information about PatientsPART 1
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 3
Adult Psychiatric Inpatient Discharges by Facility and Patient StatusPatients Age 18 and Older at First Episode Admission • Episode Ending Discharges in SFY 2018
STATUSUPDATEDOCT 2018
Western State Hospital – Forensic5% n = 896
SFY 2018 Psychiatric Inpatient
DischargesTOTAL = 16,307(Unknown = 15)
AdamsAsotin
Benton Chelan
Douglas Ferry
Franklin Garfield
Grant Columbia
KittitasKlickitatLincoln
Okanogan Pend Oreille
Skamania Stevens
Spokane Walla Walla
Whitman Yakima
Eastern Washington CountiesBased on BHO
Western Washington
CountiesBased on BHO
Clallam Clark Cowlitz Grays Harbor Island Jefferson King Kitsap Lewis
Mason Pacific Pierce San Juan Skagit Snohomish Thurston Wahkiakum Whatcom
Eastern State Hospital – Forensic2% n = 295
NOTE: The highest level of care is selected for the discharging facility since that is the direction patients usually move through the system. Thus, if a patient was in both an E&T and a Community Hospital during an episode, the discharge from the Community Hospital is counted, but not the E&T discharge.
Western State Hospital – Civil2% n = 280
Community HospitalWestern Washington Counties 56% n = 9,093
Evaluation & TreatmentWestern Washington Counties
14% n = 2,338
Community HospitalEastern Washington Counties
10% n = 1,586
Evaluation & TreatmentEastern Washington Counties
9% n = 1,424
Washington Patients Discharged from Out-of-State Facilities
1% n = 146 (Idaho = 83, Oregon = 49, Others = 14)
Eastern State Hospital – Civil1% n = 234
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 4
Episode Length for Patients Discharged from State HospitalsAdult Forensic Patients – Competency Restoration
Patients Discharged SFY 2011 through 2018Q4 • Age 18 and Older at First Admission of the Episode
5068
36
52
0
50
100
150
200
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
Median length of stay (days) by quarter
WSH Competency Restoration
ESH Competency Restoration
STATUSUPDATED OCT 2018
NOTES: Episode length is reported by the most intensive service location within an episode. Consecutive service spans are combined into a single episode of care. EXAMPLE: A patient admitted to a Community Hospital on the day of an Evaluation & Treatment discharge would be counted in the Community Hospital column and their Evaluation & Treatment days would be included in the overall length of stay. Eastern State Hospital patients with a legal authority of 72-hour or 14-day court commitment are counted as Evaluation & Treatment patients. Patients with treatment at both state hospitals in the same episode were assigned to the hospital where they spent the most time in that episode.
STATE FISCAL YEAR
2011 2013 2014 2015 2016 20172012 2018
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, October 2018.
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 5
Number and Length of Episodes for Patients Discharged from State HospitalsAdult Forensic Patient DETAIL
Median length of stay(days) by quarter
SFY 2013 SFY 2014 SFY 2015 SFY 2016 SFY 2017 SFY 2018Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
Eastern State Hospital
ALL FORENSIC 87 50 73 73 68 70 50 48 39 38 51 79 93 79 46 33 50 86 49 80 47 45 50 53
Competency Restoration 87 50 71 71 68 68 50 45 38 38 51 80 80 68 46 33 50 79 48 79 47 45 49 52
Western State Hospital
ALL FORENSIC 109 69 74 74 78 78 76 77 76 72 72 70 76 71 71 67 64 53 60 76 61 61 74 71
Competency Restoration 104 72 74 72 78 74 77 76 75 66 72 67 75 70 70 66 64 53 59 75 61 62 71 68
MEDIAN EPISODE LENGTH
NUMBER OF EPISODES
Count of episodes by quarter
SFY 2013 SFY 2014 SFY 2015 SFY 2016 SFY 2017 SFY 2018Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
Eastern State Hospital
ALL FORENSIC 37 53 27 47 30 26 39 34 38 46 36 27 36 37 63 64 63 70 74 71 74 68 68 86
Competency Restoration 35 53 26 46 30 24 39 33 35 43 36 26 35 35 63 64 62 66 73 69 74 68 64 85
Western State Hospital
ALL FORENSIC 167 142 158 143 171 165 163 179 157 192 172 164 161 191 170 222 224 231 234 248 217 227 211 241
Competency Restoration 151 120 131 125 143 147 152 166 147 183 162 158 151 184 165 214 217 221 219 231 206 214 188 212
NOTES: Episode length is reported by the most intensive service location within an episode. Consecutive service spans are combined into a single episode of care. EXAMPLE: A patient admitted to a Community Hospital on the day of an Evaluation & Treatment discharge would be counted in the Community Hospital column and their Evaluation & Treatment days would be included in the overall length of stay. Eastern State Hospital patients with a legal authority of 72-hour or 14-day court commitment are counted as Evaluation & Treatment patients. Patients with treatment at both state hospitals in the same episode were assigned to the hospital where they spent the most time in that episode.
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, October 2018.
STATUSUPDATED OCT 2018
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 6
Episode Length for Patients Discharged from State HospitalsAdult Civil Patients
49
138
93
387
0
50
100
150
200
250
300
350
400
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
Western State Hospital
Eastern State Hospital
Median length of stay (days) by quarter
NOTES: Episode length is reported by the most intensive service location within an episode. Consecutive service spans are combined into a single episode of care. EXAMPLE: A patient admitted to a Community Hospital on the day of an Evaluation & Treatment discharge would be counted in the Community Hospital column and their Evaluation & Treatment days would be included in the overall length of stay. Eastern State Hospital patients with a legal authority of 72-hour or 14-day court commitment are counted as Evaluation & Treatment patients. Patients with treatment at both state hospitals in the same episode were assigned to the hospital where they spent the most time in that episode.
STATE FISCAL YEAR
2011 2013 2014 2015 2016 20172012 2018
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, October 2018.
STATUSUPDATED OCT 2018
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 7
Episode Length for Adult Community Hospital and Evaluation and Treatment Patients
79
0
10
20
30
40
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
Evaluation & Treatment
Community Hospital
Median length of stay (days) by quarter
NOTES: Episode length is reported by the most intensive service location within an episode. Consecutive service spans are combined into a single episode of care. EXAMPLE: A patient admitted to a Community Hospital on the day of an Evaluation & Treatment discharge would be counted in the Community Hospital column and their Evaluation & Treatment days would be included in the overall length of stay. Eastern State Hospital patients with a legal authority of 72-hour or 14-day court commitment are counted as Evaluation & Treatment patients. Patients with treatment at both state hospitals in the same episode were assigned to the hospital where they spent the most time in that episode.
STATE FISCAL YEAR
2011 2013 2014 2015 2016 20172012 2018
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, October 2018.
STATUSUPDATED OCT 2018
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 8
Median length of stay (days) by quarter
SFY 2013 SFY 2014 SFY 2015Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
Eastern State Hospital – CIVIL 54 62 60 70 63 56 77 68 56 51 76 72
Western State Hospital – CIVIL 137 127 142 141 125 143 143 170 153 130 151 149
Community Hospital 8 8 8 8 9 9 9 9 9 8 8 8
Evaluation & Treatment 8 8 10 8 9 10 10 9 9 8 8 9
Median length of stay (days) by quarter
SFY 2016 SFY 2017 SFY 2018Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
Eastern State Hospital – CIVIL 62 69 81 77 69 100 95 132 123 130 115 138
Western State Hospital – CIVIL 193 201 187 288 274 260 239 216 224 276 375 387
Community Hospital 9 8 8 8 8 8 9 8 9 9 9 9
Evaluation & Treatment 9 8 9 9 9 7 9 8 8 8 7 7
Median Episode Length for Adult Civil Commitments at State Hospitals, Community Hospital and Evaluation and Treatment Patients: DETAIL
NOTES: Episode length is reported by the most intensive service location within an episode. Consecutive service spans are combined into a single episode of care. EXAMPLE: A patient admitted to a Community Hospital on the day of an Evaluation & Treatment discharge would be counted in the Community Hospital column and their Evaluation & Treatment days would be included in the overall length of stay. Eastern State Hospital patients with a legal authority of 72-hour or 14-day court commitment are counted as Evaluation & Treatment patients. Patients with treatment at both state hospitals in the same episode were assigned to the hospital where they spent the most time in that episode.
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, October 2018.
STATUSUPDATED OCT 2018
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 9
Number of episodes by quarter
SFY 2013 SFY 2014 SFY 2015Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
Eastern State Hospital – CIVIL 158 154 123 147 148 140 146 175 139 153 115 117
Western State Hospital – CIVIL 120 155 125 148 122 106 102 132 134 113 117 96
Community Hospital 1,745 1,640 1,680 1,667 1,803 1,556 1,666 1,757 1,871 1,833 1,907 1,969
Evaluation & Treatment 787 881 658 726 775 745 754 797 866 844 931 913
Number of episodes by quarter
SFY 2016 SFY 2017 SFY 2018Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
Eastern State Hospital – CIVIL 133 117 112 118 91 88 72 73 62 56 54 62
Western State Hospital – CIVIL 92 90 86 99 88 90 83 84 84 68 68 60
Community Hospital 1,967 2,001 2,311 2,436 2,601 2,552 2,645 2,698 2,677 2,627 2,763 2,778
Evaluation & Treatment 971 969 959 969 883 969 923 868 960 907 953 956
Number of Mental Health Inpatient Episodes for Adult Civil Commitments at State Hospitals, Community Hospital and Evaluation & Treatment Patients: DETAIL
NOTES: Episode length is reported by the most intensive service location within an episode. Consecutive service spans are combined into a single episode of care. EXAMPLE: A patient admitted to a Community Hospital on the day of an Evaluation & Treatment discharge would be counted in the Community Hospital column and their Evaluation & Treatment days would be included in the overall length of stay. Eastern State Hospital patients with a legal authority of 72-hour or 14-day court commitment are counted as Evaluation & Treatment patients. Patients with treatment at both state hospitals in the same episode were assigned to the hospital where they spent the most time in that episode.
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, October 2018.
STATUSUPDATED OCT 2018
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 10
State Hospital Median Length of Stay by Fiscal Year Quarter and Legal StatusExcludes time spent in other inpatient facilities prior to admission at the hospital
86
164
227
404
0
100
200
300
400
500
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
791
347
105 228
0
300
600
900
1,200
1,500
1,800
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
DETAIL: Residential days at the hospital on the first day of each fiscal quarter. No prior inpatient days at Evaluation and Treatment or Community Hospital are counted in the Length of Stay. Legal status reported for the first day of the quarter. Patients who change status (e.g. Forensic to Civil) have their LOS continued in the new status and are reported based on their legal status on the reporting date.
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, October 2017. BHSS SH Daily Census.
MEDIAN DAYS – CIVIL MEDIAN DAYS – FORENSIC
Western State Hospital
Eastern State Hospital Western State Hospital
Eastern State Hospital
STATE FISCAL YEAR STATE FISCAL YEAR
2011 2012 2013 2014 2015 2016 2017 2018 2011 2012 2013 2014 2015 2016 2017 2018
STATUSUPDATED OCT 2018
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 11
State Hospital Care MeasuresPART 2
Getty Images/iStock
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 12DSHS | Financial Services Administration | Research and Data Analysis Division ● SEPTEMBER 2018 12
Overall rates of admission screening for risk of violence to self, risk of violence to others, substance use, psychological trauma history, and patient strengths
at Eastern State Hospital and Western State Hospital
60%
96%
83%77%
0%
25%
50%
75%
100%
Q2O-N-D
Q3J-F-M
Q4A-M-J
Q1J-A-S
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Q3J-F-M
Q4A-M-J
2014 2015 2016
Western State Hospital
Eastern State HospitalNational Average
Target = 100%
DATA SOURCE: Reports from Eastern State Hospital and Western State Hospital. National average from NRI’s HBIPS Comparative Statistics Report (HAP and BHC).MEASURE DEFINITION: Overall rates of multi-factor admission screening conducted by the third day post admission. Measure is calculated when patient is discharged.DATA NOTES: 1 Overall rate calculations: Numerator = Psychiatric inpatients with admission screening by the third day post admission for all of the following: a) risk of violence to self, b) risk of violence to others, c) substance use, d) psychological trauma history, and e) patient strengths. Denominator = All psychiatric inpatient discharges. 2 Included populations in the denominator are patients with ICD-9-CM Principal or Other Diagnosis Codes for Mental Disorders. 3 2016 Q3 reflects a change to the screening form data which was required by CMS.
HBIPS 1a
http://emis.dshs.wa.gov/Report/View?definition=HBIPS%201a*197901-999906*15973&format=excel
2017
STATUSUPDATED SEP 2018
NEXT UPDATEOCT 2018
STATE FISCAL YEAR
2018
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 13
11.8
18.316.0
22.1
0
5
10
15
20
25
Q1J-A-S
Q2O-S-N
Q3J-F-M
Q4A-M-J
Q1J-A-S
Q2O-S-N
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Q4A-M-J
Q1J-A-S
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Q1J-A-S
Q2O-S-N
Western State Hospital
Eastern State Hospital
Prior Eastern State Hospital Target (through SFY 2018) = 15.00
DATA SOURCE: Reports from Eastern State Hospital and Western State Hospital.MEASURE DEFINITION: Active treatment hours delivered (per 7 patient days) during the reporting quarter, at each of Eastern State Hospital and Western State Hospital. Includes both civil and forensic patients.DATA NOTES: 1 The performance targets will be reached on or prior to June 30, 2017. 2 The rate is calculated by dividing the number of active treatment hours delivered in a given quarter by the number of patient days utilized by a state hospital in that quarter; and then multiplying the quotient by seven. 3 Active treatment hours are distinctly tracked for each of the state hospitals, for purposes of calculating quarterly rates by facility.
Quarterly rates of active treatment hours delivered per 7 patient days at Eastern State Hospital and Western State Hospital for all patients
Rate per 7 patient days
Overall Target = 20.0
SP 1.2 (ABX.5)
STATUSUPDATED SEP 2018
NEXT UPDATEDEC 2018
http://emis.dshs.wa.gov/Report/View?definition=ABX.5*197901-999906*10689&format=excel
2014 2015 2016 2017
STATE FISCAL YEAR
2018 2019
Eastern State Hospital Target Increased to 20.0
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 14
Rate of Aggression, Injury, Assault, Seclusion and Restraint at Western State Hospital
0.070.11
0.92
0.00
0.20
0.40
0.60
0.80
1.00
Q3J-F-M
Q4A-M-J
Q1J-A-S
Q2O-N-D
Q3J-F-M
Q4A-M-J
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Q2O-N-D
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Q2O-N-D
Q3J-F-M
Q4A-M-J
Patient to Patient AggressionSevere Patient Injuries
Patient to Staff Assaults
Rate per 1,000 Patient Days at Western State
0.25 0.670.00
2.00
4.00
6.00
8.00
10.00
Q3J-F-M
Q4A-M-J
Q1J-A-S
Q2O-N-D
Q3J-F-M
Q4A-M-J
Q1J-A-S
Q2O-N-D
Q3J-F-M
Q4A-M-J
Q1J-A-S
Q2O-N-D
Q3J-F-M
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Q1J-A-S
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Q3J-F-M
Q4A-M-J
Q1J-A-S
Q2O-N-D
Q3J-F-M
Q4A-M-J
Q1J-A-S
Q2O-N-D
Q3J-F-M
Q4A-M-J
Q1J-A-S
Q2O-N-D
Q3J-F-M
Q4A-M-J
Restraint
Seclusion
Rate per 1,000 Patient Hours at Western State
NOTE: Incidents are distinctly tracked for each of the state hospitals, for purposes of mapping rates by facility. 2 An injury occurs when a patient suffers physical harm or damage, excluding the result of a disease process. Severe patient injuries include all patient injuries with a severity level of "3" or higher (3 = medical intervention; 4 = hospitalization; 5 = death)..SOURCES: Reports from Eastern State Hospital and Western State Hospital.
https://www.dshs.wa.gov/data/metrics/AB3.2.xlsx | https://www.dshs.wa.gov/data/metrics/ABX.7.xlsx | https://www.dshs.wa.gov/data/metrics/ABX.8.xlsx
SP 3.2 (AB3.2), ABX.7, ABX.8, ABX3.1, ABX4.1
https://www.dshs.wa.gov/data/metrics/ABX3.1.xlsx | https://www.dshs.wa.gov/data/metrics/ABX4.1.xlsx
STATUSUPDATED SEP 2018
NEXT UPDATEOCT 2018
2012 2013 2014 2015 2016 2017 2018
STATE FISCAL YEAR
2012 2013 2014 2015 2016 2017 2018
STATE FISCAL YEAR
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 15
Rate of Aggression, Injury, Assault, Seclusion and Restraint at Eastern State Hospital
0.040.04
0.46
0.00
0.20
0.40
0.60
0.80
1.00
Q3J-F-M
Q4A-M-J
Q1J-A-S
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Patient to Patient Aggression Severe Patient InjuriesPatient to Staff Assaults
Rate per 1,000 Patient Days at Eastern State
2.62
0.050.00
2.00
4.00
6.00
8.00
10.00
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Restraint
SeclusionRate per 1,000 Patient Hours at Eastern State
NOTE: Incidents are distinctly tracked for each of the state hospitals, for purposes of mapping rates by facility. 2 An injury occurs when a patient suffers physical harm or damage, excluding the result of a disease process. Severe patient injuries include all patient injuries with a severity level of "3" or higher (3 = medical intervention; 4 = hospitalization; 5 = death)..SOURCES: Reports from Eastern State Hospital and Western State Hospital.
https://www.dshs.wa.gov/data/metrics/AB3.2.xlsx | https://www.dshs.wa.gov/data/metrics/ABX.7.xlsx | https://www.dshs.wa.gov/data/metrics/ABX.8.xlsx
SP 3.2 (AB3.2), ABX.7, ABX.8, ABX3.1, ABX4.1
https://www.dshs.wa.gov/data/metrics/ABX3.1.xlsx | https://www.dshs.wa.gov/data/metrics/ABX4.1.xlsx
STATUSUPDATED SEP 2018
NEXT UPDATEOCT 2018
2012 2013 2014 2015 2016 2017
2012 2013 2014 2015 2016 2017
2018
2018
STATE FISCAL YEAR
STATE FISCAL YEAR
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 16
1%
33%
69%
73%
14%
64%
100%
100%
0%
25%
50%
75%
100%
Q2O-S-N
Q3J-F-M
Q4A-M-J
Q1J-A-S
Q2O-S-N
Q3J-F-M
Q4A-M-J
Q1J-A-S
Q2O-S-N
Q3J-F-M
Q4A-M-J
Q1J-A-S
Q2O-S-N
Q3J-F-M
Q4A-M-J
Q1J-A-S
Q2O-S-N
Q3J-F-M
Q4A-M-J
DSHS | Financial Services Administration | Research and Data Analysis Division ● SEPTEMBER 2018 16
Eastern State Hospital
Prior National Average
Prior Target = 100%
DATA SOURCE: Reports from Eastern State Hospital and Western State Hospital. National average from NRI’s HBIPS Comparative Statistics Report (HAP and BHC).MEASURE DEFINITION: Overall rates of post discharge continuing care plan.DATA NOTES: 1 This measure has been discontinued as a Hospital-Based Inpatient Psychiatric Services Measure. Related replacement measures will be available when data is compiled for January-March 2017. 2 Overall rate calculations: Numerator: Inpatients for whom the post discharge continuing care plan is created and contains all of the following: reason for hospitalization, principal discharge diagnosis, discharge medications and next level of care recommendations. Denominator: Inpatient discharges. 3 Included populations: Patients referred for next level of care with mental disorder diagnoses.
Overall rates of post discharge continuing care plans created at Eastern State Hospital and Western State Hospital
BH7
Western State Hospital
NOTE: This measure was discontinued as of October-December 2015. Replacement measure (at right) began January-March 2017.
http://emis.dshs.wa.gov/Report/View?definition=BH7*197901-999906*20653&format=excel
WSH
PRIOR MEASURE
ENDS
NEW MEASURE BEGINS
As of Jan 2017, these items are required in the Transition Record:INPATIENT CARE• Reason for inpatient
admission• Major procedures and tests• Principal diagnosis at
dischargePOST-DISCHARGE/PATIENT SELF-MANAGEMENT• Current medication list• Studies pending at discharge• Patient instructionsADVANCED CARE PLAN• Advance directiveCONTACT INFORMATION/PLAN FOR FOLLOW-UP CARE• 24-hour/7-day contact for
emergencies• Contact information for
studies pending at discharge• Plan for follow-up care• Primary physician ESH
New National Average
STATUSUPDATED SEP 2018
NEXT UPDATEOCT 2018
2014 2015 2016 2017
STATE FISCAL YEAR
2018
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 17DSHS | Financial Services Administration | Research and Data Analysis Division ● SEPTEMBER 2018 17
Overall rates of post discharge continuing care plans transmitted to next level of care provider upon discharge at
Eastern State Hospital and Western State Hospital
85% 81%
0%
37%
67% 71%
16%
68%
0%
25%
50%
75%
100%
Q2O-N-D
Q3J-F-M
Q4A-M-J
Q1J-A-S
Q2O-N-D
Q3J-F-M
Q4A-M-J
Q1J-A-S
Q2O-N-D
Q3J-F-M
Q4A-M-J
Q1J-A-S
Q2O-N-D
Q3J-F-M
Q4A-M-J
Q1J-A-S
Q2O-N-D
Q3J-F-M
Q4A-M-J
Eastern State Hospital
DATA SOURCE: Reports from Eastern State Hospital and Western State Hospital. National average from NRI’s HBIPS Comparative Statistics Report (HAP and BHC).MEASURE DEFINITION: Overall rates of post discharge continuing care plan transmitted to next level of care provider upon discharge.DATA NOTES: 1 This measure has been discontinued as a Hospital-Based Inpatient Psychiatric Services Measure. Related replacement measures will be available when data is compiled for January-March 2017. 2 Overall rate calculations: Numerator: inpatients for whom the post discharge continuing care plan was transmitted to the next level of care clinician or entity. Denominator: inpatient discharges. 3 Included populations: Patients referred for next level of care with mental disorder diagnoses.
BH8
Prior National Average
Prior Target = 100%
Western State Hospital
http://emis.dshs.wa.gov/Report/View?definition=BH8*197901-999906*20654&format=excel
WSH
ESH
New National Average
STATUSUPDATED SEP 2018
NEXT UPDATEOCT 2018
2014 2015 2016 2017
STATE FISCAL YEAR
2018
NOTE: This measure was discontinued as of October-December 2015. Replacement measure (at right) began January-March 2017.
PRIOR MEASURE
ENDS
NEW MEASURE BEGINS
As of Jan 2017, these items are required in the Transition Record:INPATIENT CARE• Reason for inpatient
admission• Major procedures and tests• Principal diagnosis at
dischargePOST-DISCHARGE/PATIENT SELF-MANAGEMENT• Current medication list• Studies pending at discharge• Patient instructionsADVANCED CARE PLAN• Advance directiveCONTACT INFORMATION/PLAN FOR FOLLOW-UP CARE• 24-hour/7-day contact for
emergencies• Contact information for
studies pending at discharge• Plan for follow-up care• Primary physician
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 18DSHS | Financial Services Administration | Research and Data Analysis Division ● SEPTEMBER 2018 18
Overall rates of patients discharged on multiple antipsychotic medications with appropriate justification at Eastern State Hospital and Western State Hospital
50%
94%
12%
87%
0%
25%
50%
75%
100%
Q2O-N-D
Q3J-F-M
Q4A-M-J
Q1J-A-S
Q2O-N-D
Q3J-F-M
Q4A-M-J
Q1J-A-S
Q2O-N-D
Q3J-F-M
Q4A-M-J
Q1J-A-S
Q2O-N-D
Q3J-F-M
Q4A-M-J
Q1J-A-S
Q2O-N-D
Q3J-F-M
Q4A-M-J
Western State Hospital
Eastern State Hospital
National Average
Target = 100%
DATA SOURCE: Reports from Eastern State Hospital and Western State Hospital. National average from NRI’s HBIPS Comparative Statistics Report (HAP and BHC).MEASURE DEFINITION: Overall rates of patients discharged from a hospital-based inpatient psychiatric setting on two or more antipsychotic medications with appropriate justification.DATA NOTES: 1 Overall rate calculations: Numerator: psychiatric inpatients discharged on two or more routinely scheduled antipsychotic medications with appropriate justification. Denominator: psychiatric inpatient discharges on two or more routinely scheduled antipsychotic medications. 2 Included populations in the denominator are patients with ICD-9-CM Principal or Other Diagnosis Codes for Mental Disorders.
HBIPS 5a
http://emis.dshs.wa.gov/Report/View?definition=HBIPS.5a*197901-999906*16027&format=excel
STATUSUPDATED SEP 2018
NEXT UPDATEOCT 2018
2014 2015 2016 2017
STATE FISCAL YEAR
2018
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 19
Measures Related to the Trueblood CasePART 3
Getty Images/iStock
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 20
DATA SOURCE: FES modules in Cache database(WSH) and MILO database(ESH).MEASURE DEFINITION: For all Trueblood class member court orders for jail-based competency evaluations completed in the specified month, the average number of days from order signature to completed evaluation.
Jail-based Competency EvaluationsTimely response to Trueblood class member court orders
Average number of days from court order signature to completed evaluation
BH 21
Court Ordered Limit = 14 days
STATUSUPDATED OCT 2018
NEXT UPDATENOV 2018
61.3
10.614.6
9.80
25
50
75
100AP
R
MAY JUN
JUL
AUG
SEP
OCT
NO
V
DEC
JAN
FEB
MAR AP
R
MAY JUN
JUL
AUG
SEP
OCT
NO
V
DEC
JAN
FEB
MAR AP
R
MAY JUN
JUL
AUG
SEP
OCT
NO
V
DEC
JAN
FEB
MAR AP
R
MAY JUN
2015
Western State Hospital
Eastern State Hospital
Limit = 7 days
2016 2017
Limit = 21 days
CALENDAR YEAR
2018
Limit = 14 days
Regarding 14-DAY and 21 DAY Court Ordered Limits: Compliance deadlines: 14 days from receipt of order (if the order was received within 0 and 7 days from order signature date) or 21 days from order signature date (if the order was received after 7 days from order signature date).
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 21
Complete within . . . = Pending = 21+ days = 21 days = 14 days
93%
99%
95%
93%
94%
92%
93%
94%
94%
94%
90%
87%
91%
90%
94%
95%
92%
88%
100%
98%
91%
91%
97%
95%
5569
61 6036
65 58 5462
5269 68
5472
4962 63
5273
6476
5363 65
0
50
100
150
200
250
300
350
JUL
AUG
SEP
OCT
NO
VDE
CJA
NFE
BM
AR APR
MAY JUN
JUL
AUG
SEP
OCT
NO
VDE
CJA
NFE
BM
AR APR
MAY JUN
Eastern State Hospital
SFY 2017 SFY 2018
Total court orders signed is shown in BOLD
DATA SOURCE: FES modules in Cache database(WSH) and MILO database(ESH).MEASURE DEFINITION: For all Trueblood class member court orders for jail-based competency evaluations completed within 14 days from receipt of court order or 21 days from order signature in the specified month.
Completed Jail-based Competency Evaluations Timely response to Trueblood class member court orders
Number of competency evaluations complete within 14 days from receipt of order or 21 days from signature of order
UPDATED OCT 2018
NEXT UPDATENOV 2018
STATUS
BH 21
Complete within . . . = Pending = 21+ days = 21 days = 14 days
73%
73%
68%
80%
66%
72%
79%
86%
84%
83%
70%
64%
74%
74%
72%
80%
90%
96%
95%
98%
96%
96%
97%
95%
25% 25
%32
%19
%34
%27
%21
%13
%14
%17
% 30%
36%
25%
26%
27%
19%
8%
224 23
025
323
620
518
8 197
178
249
213
257 27
021
826
823
6 254 259
181
226 23
426
826
130
128
0
0
50
100
150
200
250
300
350
JUL
AUG
SEP
OCT
NO
VDE
CJA
NFE
BM
AR APR
MAY JUN
JUL
AUG
SEP
OCT
NO
VDE
CJA
NFE
BM
AR APR
MAY JUN
Western State Hospital
SFY 2017 SFY 2018
Total court orders signed is shown in BOLD
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 22
DATA SOURCE: FES modules in Cache database(WSH) and MILO database(ESH).MEASURE DEFINITION: For all Trueblood class member court orders for inpatient competency evaluations completed in the specified month, the average number of days from order signature to hospital admission for evaluation.
Inpatient Competency Evaluations Timely response to Trueblood class member court orders
Average number of days from court order signature to hospital admission for evaluation
BH 20
56.3
23.822.2
11.5
0
25
50
75
100AP
R
MAY JUN
JUL
AUG
SEP
OCT
NO
V
DEC
JAN
FEB
MAR AP
R
MAY JUN
JUL
AUG
SEP
OCT
NO
V
DEC
JAN
FEB
MAR AP
R
MAY JUN
JUL
AUG
SEP
OCT
NO
V
DEC
JAN
FEB
MAR AP
R
MAY JUN
2015 2016
Western State Hospital
Eastern State Hospital
Limit = 7 days
2017
STATUSUPDATED OCT 2018
NEXT UPDATENOV 2018
CALENDAR YEAR
2018
Limit = 14 days
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 23
Complete within . . . = Pending = 14+ days = 14 days = 7 days
92%
91%
100%
67%
89%
73%
80%
100%
90%
50%
50%
33%
38%
67%
88%
27%
20%
83%
50%
50%
67%
63%
89%
80%
33%
100%
83%
83%
90%
100%
212
1112
69
1110
610
610
89
89
59
85
126
10 10
0
10
20
30
40
JUL
AUG
SEP
OCT
NO
VDE
CJA
NFE
BM
AR APR
MAY JUN
JUL
AUG
SEP
OCT
NO
VDE
CJA
NFE
BM
AR APR
MAY JUN
Eastern State Hospital
SFY 2017 SFY 2018
Total court orders signed is shown in BOLD
Complete within . . . = Pending = 14+ days = 14 days = 7 days
Western State Hospital
DATA SOURCE: FES modules in Cache database(WSH) and MILO database(ESH).MEASURE DEFINITION: For all Trueblood class member court orders for inpatient competency evaluations completed within 7 days from receipt of court order or 14 days from order signature in the specified month.
Admissions for Inpatient Competency EvaluationsTimely response to Trueblood class member court orders
Number of admissions for inpatient competency evaluations within 7 days from receipt of order or 14 days from signature of order
BH 20
UPDATED OCT 2018
NEXT UPDATENOV 2018
STATUS
23%
27%
26%
25%
33%
16%
31%
14%
23%
25%
46%
44%
56%
77%
73%
74%
87%
90%
75%
67%
84%
91%
97%
84%
84%
69%
86% 77
%75
%10
0%81
%82
%67
%54
%90
%56
%22
%
0%
22%
2233
2723
2120
1519
2329
2519
1629
2216
1516
176
1310
1618
0
10
20
30
40
JUL
AUG
SEP
OCT
NO
VDE
CJA
NFE
BM
AR APR
MAY JUN
JUL
AUG
SEP
OCT
NO
VDE
CJA
NFE
BM
AR APR
MAY JUN
Western State Hospital
SFY 2017 SFY 2018
Total court orders signed is shown in BOLD
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 24
DATA SOURCE: FES modules in Cache database(WSH) and MILO database(ESH).MEASURE DEFINITION: For all court orders for competency restoration placement completed in the specified month, the average number of days from order signature to hospital admission.
Competency Restoration Services Timely response to Trueblood class member court ordersAverage number of days from court order signature to hospital admission
BH 22
54.7
26.6
38.6
11.9
0
25
50
75
100AP
R
MAY JUN
JUL
AUG
SEP
OCT
NO
V
DEC
JAN
FEB
MAR AP
R
MAY JUN
JUL
AUG
SEP
OCT
NO
V
DEC
JAN
FEB
MAR AP
R
MAY JUN
JUL
AUG
SEP
OCT
NO
V
DEC
JAN
FEB
MAR AP
R
MAY JUN
2015
Western State Hospital
Eastern State Hospital
2016 2017
CALENDAR YEAR
2018
Limit = 7 days
Limit = 14 days
UPDATED OCT 2018
NEXT UPDATENOV 2018
STATUS
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 25
DATA SOURCE: FES modules in Cache database(WSH) and MILO database(ESH).MEASURE DEFINITION: For all Trueblood class member court orders for competency restoration services completed within 7 days from receipt of court order or 14 days from order signature in the specified month.
Competency Restoration Services Timely response to Trueblood class member court orders
Number of hospital admissions within 7 days from receipt of court order or 14 days from signature of order
BH 22
UPDATED OCT 2018
NEXT UPDATENOV 2018
STATUS
Complete within . . . = Pending = 14+ days = 14 days = 7 days
91%
95%
68%
56%
92%
74%
64%
89%
56%
47%
76%
32%
44% 26
%36
%
44%
53%
68%
94% 64
% 68%
79%
85%
94%
100% 91
%
117
22 1918
1219 22
18 18 1913 14
2216
11 1222
17 19 2016
2023
0
25
50
75
100
125
JUL
AUG
SEP
OCT
NO
VDE
CJA
NFE
BM
AR APR
MAY JUN
JUL
AUG
SEP
OCT
NO
VDE
CJA
NFE
BM
AR APR
MAY JUN
Eastern State Hospital
SFY 2017 SFY 2018
Total court orders signed is shown in BOLD
Complete within . . . = Pending = 14+ days = 14 days = 7 days
Western State Hospital
31%
29%
22%
17%
37%
20%
23%
27%
20%
31%
24%
26%
21%
69%
71%
78%
81%
74%
83%
63%
69%
77%
84%
79% 77
%76
% 73%
80%
68%
69%
66%
84%
78% 75
%79
% 46%
31%
28%
48%
6795
104
7582
9682
9510
777
100
100
9810
898
105
9180 79
95 9512
196 98
0
25
50
75
100
125
JUL
AUG
SEP
OCT
NO
VDE
CJA
NFE
BM
AR APR
MAY JUN
JUL
AUG
SEP
OCT
NO
VDE
CJA
NFE
BM
AR APR
MAY JUN
Western State Hospital
SFY 2017 SFY 2018
Total court orders signed is shown in BOLD
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 26
Outcomes after DischargePART 4
Getty Images/iStock
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 27
DATA NOTES: • Readmission to a State Hospital, Community Psychiatric Hospital, or Evaluation & Treatment facility is included, with the exception of the competency
restoration facilities in Yakima and Maple Lane.• Contiguous inpatient stays do not count as readmission, they are joined into an episode of care. In most cases, inpatient episodes end when there is at least
one day between a discharge and a subsequent admission at another inpatient setting. For discharges from a state hospital to a jail or medical facility, readmissions to the hospital within 30-days are considered a continuation of the episode.
Psychiatric ReadmissionsPART 4a
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 28
Forensic Discharges with Any Type of Inpatient Psychiatric Readmission*
Percent readmitted to any psychiatric inpatient facility following discharge by State Fiscal Year
30-DAY PSYCHIATRIC READMISSION
4% 5% 5% 5% 6% 8%
0%
50%
2012 2013 2014 2015 2016 2017
Western State Hospital – Forensic
2% 3% 3% 4% 4% 6%
0%
50%
2012 2013 2014 2015 2016 2017
Eastern State Hospital – Forensic
180-DAY PSYCHIATRIC READMISSION
24% 24%26% 25% 26% 25%
0%
50%
2012 2013 2014 2015 2016 2017
Western State Hospital – Forensic
15% 15% 15%
22%17% 17%
0%
50%
2012 2013 2014 2015 2016 2017
Eastern State Hospital – Forensic
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, May 2018.
23 of 654 28 of 608 34 of 672 37 of 683 43 of 742 73 of 943
3 of 155 4 of 159 4 of 119 5 of 138 7 of 197 15 of 265
159 of 654 144 of 608 175 of 672 173 of 683 195 of 742 240 of 943
23 of 155 24 of 159 18 of 119 31 of 138 33 of 197 45 of 265
NOTE: *Readmission to any psychiatric inpatient setting including the competency restoration facilities in Yakima and Maple Lane.
STATUSUPDATEDMAY 2018
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 29
Civil Discharges with Any Type of Inpatient Psychiatric Readmission*
Percent readmitted to any psychiatric inpatient facility following discharge by State Fiscal Year
30-DAY PSYCHIATRIC READMISSION
6% 9% 9% 10% 8%5%
0%
50%
2012 2013 2014 2015 2016 2017
Western State Hospital – Civil
11% 10%7%
10% 10% 9%
0%
50%
2012 2013 2014 2015 2016 2017
Eastern State Hospital – Civil
180-DAY PSYCHIATRIC READMISSION
25%29% 27% 29%
33%
26%
0%
50%
2012 2013 2014 2015 2016 2017
Western State Hospital – Civil
30% 30%24%
28% 31%28%
0%
50%
2012 2013 2014 2015 2016 2017
Eastern State Hospital – Civil
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, May 2018.
30 of 484 47 of 546 43 of 459 45 of 459 30 of 366 19 of 348
65 of 599 54 of 516 37 of 548 49 of 478 48 of 458 29 of 319
119 of 484 157 of 546 123 of 459 131 of 459 120 of 366 90 of 348
178 of 599 153 of 516 130 of 548 136 of 478 142 of 458 90 of 319
NOTE: *Readmission to any psychiatric inpatient setting including the competency restoration facilities in Yakima and Maple Lane.
STATUSUPDATEDMAY 2018
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 30
Community Hospital and E&T Discharges with Any Type of Inpatient Psychiatric Readmission*
Percent readmitted to any psychiatric inpatient facility following discharge by State Fiscal Year
30-DAY PSYCHIATRIC READMISSION
11% 10% 11% 11% 11% 11%
0%
50%
2012 2013 2014 2015 2016 2017
Community Hospitals
14% 14% 13% 14% 15%20%
0%
50%
2012 2013 2014 2015 2016 2017
Evaluation & Treatment Centers
180-DAY PSYCHIATRIC READMISSION
25% 25% 26% 28% 27% 27%
0%
50%
2012 2013 2014 2015 2016 2017
Community Hospitals
31% 32% 30% 30% 31%
39%
0%
50%
2012 2013 2014 2015 2016 2017
Evaluation & Treatment Centers
679 of 6,407 656 of 6,543 736 of 6,545 860 of 7,493 923 of 8,569 1,154 of 10,172
342 of 2,479 473 of 3,305 438 of 3,360 531 of 3,682 586 of 4,020 802 of 3,913
1,617 of 6,407 1,618 of 6,543 1,684 of 6,545 2,068 of 7,493 2,284 of 8,569 2,705 of 10,172
769 of 2,479 1,065 of 3,305 1,011 of 3,360 1,116 of 3,682 1,264 of 4,020 1,508 of 3,913
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, May 2018.
NOTE: *Readmission to any psychiatric inpatient setting including the competency restoration facilities in Yakima and Maple Lane.
STATUSUPDATEDMAY 2018
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 31
Death Following ExitPART 4b
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 32
Cause of Death Following Exit – All Inpatient Settings For patients aged 18 and older at first admission in an episode ending in the 6-year period from 7/1/2011 through 6/30/2017
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, May 2018.
62%17%
8%5%
3%3%3%2%2%1.5%1.5%0.8%0.8%0.8%0.4%
14.2%
36%16%18%
15%
1.5%
NATURAL CAUSES
Dementia
Heart disease
Malignant neoplasms (cancer)
Cerebrovascular diseases (stroke)
*Behavioral health disorders
Diabetes mellitus
Chronic liver disease and cirrhosis
Chronic Obstructive Pulmonary Disease (COPD)
Essential hypertension and hypertensive renal disease
Influenza and pneumonia
Parkinson’s disease
Renal failure
Viral hepatitis
Human immunodeficiency virus (HIV) disease
Other natural causes
UNNATURAL CAUSES
Suicide
Unintentional
Undetermined
UNKNOWN
NATURAL CAUSES
UNNATURAL CAUSES
UNKNOWN
60%12%
10%7%
3%3%3%2%2%1.2%1.0%0.8%0.7%0.7%0.7%0.4%
14%
38%18%
17%1.9%1.0%0.1%
1.6%
NATURAL CAUSESDementia
Heart diseaseMalignant neoplasms (cancer)
*Behavioral health disordersChronic Obstructive Pulmonary Disease (COPD)
Diabetes mellitusCerebrovascular diseases (stroke)Chronic liver disease and cirrhosis
Influenza and pneumoniaEssential hypertension and hypertensive renal disease
Human immunodeficiency virus (HIV) diseaseRenal failure
SepticemiaViral hepatitis
Parkinson’s diseaseOther natural causes
UNNATURAL CAUSES Suicide
Unintentional Undetermined
Homicide Legal intervention
UNKNOWN
NATURAL CAUSES
UNNATURAL CAUSES
UNKNOWN
30-day Mortality Rate
All discharges, all facilitiesSFY 2012-2017
0.5%Deaths = 269 of 49,884
patients
180-day Mortality Rate
All discharges, all facilitiesSFY 2012-2017
1.8%Deaths = 902 of 49,884
patients
*Cause of death taken from DOH death records. Behavioral Health Disorders includes death caused by IDC-10 codes F10-F99. Unintentional includes drug/alcohol poisoning, fall, suffocation, drowning, etc. Legal intervention includes injuries inflicted by the police or other law-enforcing agents.
Overall Mortality
Overall Mortality
CAUSE OF DEATH WITHIN 30 DAYSTOTAL DEATHS = 269
CAUSE OF DEATH WITHIN 180 DAYSTOTAL DEATHS = 902
STATUSUPDATED MAY 2018
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 33
1.3%
0% 0% 0% 0%
1.5%
0%
5%
2012 2013 2014 2015 2016 2017
Forensic Discharges with Death Occurring Following ExitPercent by final facility in an episode and State Fiscal Year
DEATH WITHIN 30 DAYS
0% 0% 0.1% 0% 0% 0%0%
5%
2012 2013 2014 2015 2016 2017
Western State Hospital – Forensic
Eastern State Hospital – Forensic
DEATH WITHIN 180 DAYS
0.3%0.7%
0.9% 0.7%1.2%
0.4%
0%
5%
2012 2013 2014 2015 2016 2017
Western State Hospital – Forensic
2.6%
0.0%
0.8%
0.0%
2.0%1.5%
0%
5%
2012 2013 2014 2015 2016 2017
Eastern State Hospital – Forensic
0 of 654 0 of 608 1 of 672 0 of 683 0 of 742 0 of 943
2 of 155 0 of 159 0 of 119 0 of 138 0 of 197 4 of 265
2 of 654 4 of 608 6 of 672 5 of 683 9 of 742 4 of 943
4 of 155 0 of 159 1 of 119 0 of 138 4 of 197 4 of 265
STATUSUPDATED MAY 2018
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, May 2018.
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 34
Civil Discharges with Death Occurring Following Exit Percent by final facility in an episode and State Fiscal Year
DEATH WITHIN 30 DAYS
0.4% 0.9% 0.9%0.2%
1.6%0.3%
0%
10%
2012 2013 2014 2015 2016 2017
Western State Hospital – Civil
0.3%1.0%
0.4% 0.4% 0.4%
2.2%
0%
10%
2012 2013 2014 2015 2016 2017
Eastern State Hospital – Civil
DEATH WITHIN 180 DAYS
2.1%1.5%
2.4%1.1%
2.7%1.4%
0%
10%
2012 2013 2014 2015 2016 2017
Western State Hospital – Civil
1.3%2.1%
0.9% 1.0%2.0%
3.8%
0%
10%
2012 2013 2014 2015 2016 2017
Eastern State Hospital – Civil
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, May 2018.
2 of 484 5 of 546 4 of 459 1 of 459 6 of 366 1 of 348
2 of 599 5 of 516 2 of 548 2 of 478 2 of 458 7 of 319
10 of 484 8 of 546 11 of 459 5 of 459 10 of 366 5 of 348
8 of 599 11 of 516 5 of 548 5 of 478 9 of 458 12 of 319
STATUSUPDATED MAY 2018
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 35
Community Hospital and E&T Discharges with Death Occurring Following ExitPercent by final facility in an episode and State Fiscal Year
DEATH WITHIN 30 DAYS
0.5% 0.5% 0.4% 0.4% 0.4% 0.4%
0%
5%
2012 2013 2014 2015 2016 2017
Community Hospitals
0.1% 0.2% 0.2% 0.3% 0.3% 0.2%0%
5%
2012 2013 2014 2015 2016 2017
Evaluation & Treatment Centers
DEATH WITHIN 180 DAYS
1.7% 1.5% 1.3% 1.5% 1.5% 1.5%
0%
5%
2012 2013 2014 2015 2016 2017
Community Hospitals
1.1% 1.1% 1.1% 1.0% 0.7%1.2%
0%
5%
2012 2013 2014 2015 2016 2017
Evaluation & Treatment Centers
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, May 2018.
30 of 6,407 31 of 6,543 24 of 6,545 30 of 7,493 36 of 8,569 38 of 10,172
3 of 2,479 7 of 3,305 7 of 3,360 10 of 3,682 12 of 4,020 9 of 3,913
110 of 6,407 100 of 6,543 88 of 6,545 113 of 7,493 131 of 8,569 151 of 10,172
28 of 2,479 37 of 3,305 37 of 3,360 36 of 3,682 30 of 4,020 46 of 3,913
STATUSUPDATED MAY 2018
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 36
Risk Factors (Arrests, Homelessness)PART 4c
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 37
Forensic Discharges with Arrests Following ExitPercent by final facility in an episode and State Fiscal Year
ARRESTED WITHIN 1 MONTH
13%10% 12% 14% 14% 12%
0%
50%
2012 2013 2014 2015 2016 2017
Western State Hospital – Forensic
6%9% 9% 10%
6% 8%
0%
50%
2012 2013 2014 2015 2016 2017
Eastern State Hospital – Forensic
ARRESTED WITHIN 6 MONTHS
26% 25%28% 29% 30% 29%
0%
50%
2012 2013 2014 2015 2016 2017
Western State Hospital – Forensic
17%21% 23% 24%
17%22%
0%
50%
2012 2013 2014 2015 2016 2017
Eastern State Hospital – Forensic
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, May 2018. Charges for felonies and gross misdemeanors reported by WA State Patrol.
84 of 654 62 of 608 78 of 672 97 of 683 102 of 742 109 of 943
10 of 155 15 of 159 11 of 119 14 of 138 12 of 197 21 of 265
170 of 654 152 of 608 190 of 672 200 of 683 224 of 742 270 of 943
27 of 155 33 of 159 27 of 119 33 of 138 34 of 197 59 of 265
STATUSUPDATED MAY 2018
NOTE: Forensic data includes competency restoration facilities in Yakima and Maple Lane. In instances where the arrest appears in the same month as the state hospital discharge, the admission date must be prior to the start of that month.
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 38
Civil Discharges with Arrests Following ExitPercent by final facility in an episode and State Fiscal Year
7%5% 5%
7%5% 5%
0%
30%
2012 2013 2014 2015 2016 2017
Western State Hospital – Civil
6% 5% 6% 4% 5% 6%
0%
30%
2012 2013 2014 2015 2016 2017
Eastern State Hospital – Civil
14%12% 13%
15%12%
10%
0%
30%
2012 2013 2014 2015 2016 2017
Western State Hospital – Civil
9%13% 11% 11% 12%
15%
0%
30%
2012 2013 2014 2015 2016 2017
Eastern State Hospital – Civil
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, May 2018. Charges for felonies and gross misdemeanors.
36 of 484 27 of 546 23 of 459 34 of 459 19 of 366 17 of 348
33 of 599 25 of 516 31 of 548 21 of 478 24 of 458 19 of 319
68 of 484 63 of 546 58 of 459 68 of 459 44 of 366 35 of 348
55 of 599 65 of 516 63 of 548 52 of 478 55 of 458 48 of 319
ARRESTED WITHIN 1 MONTH ARRESTED WITHIN 6 MONTHS
STATUSUPDATED MAY 2018
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 39
Community Hospital and E&T Discharges with Arrests Following ExitPercent by final facility in an episode and State Fiscal Year
9% 9% 9% 10% 9% 10%
0%
30%
2012 2013 2014 2015 2016 2017
Community Hospitals
11% 12%10% 10% 10%
12%
0%
30%
2012 2013 2014 2015 2016 2017
Evaluation & Treatment Centers
16% 17% 17% 17% 17% 17%
0%
30%
2012 2013 2014 2015 2016 2017
Community Hospitals
21% 21%19% 18% 19%
21%
0%
30%
2012 2013 2014 2015 2016 2017
Evaluation & Treatment Centers
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, May 2018.
556 of 6,407 566 of 6,543 612 of 6,545 731 of 7,493 790 of 8,569 1,000 of 10,172
276 of 2,479 407 of 3,305 335 of 3,360 383 of 3,682 395 of 4,020 488 of 3,913
1,056 of 6,407 1,087 of 6,543 1,121 of 6,545 1,299 of 7,493 1,433 of 8,569 1,780 of 10,172
514 of 2,479 695 of 3,305 642 of 3,360 653 of 3,682 775 of 4,020 836 of 3,913
ARRESTED WITHIN 1 MONTH ARRESTED WITHIN 6 MONTHS
STATUSUPDATED MAY 2018
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 40
Forensic Discharges with Homelessness Following ExitPercent by final facility in an episode and State Fiscal Year| Narrow Definition of Homelessness, Non-adjusted
HOMELESS WITHIN 1 MONTH
11%8%
13%10%
11% 11%
0%
30%
2012 2013 2014 2015 2016 2017
Western State Hospital – Forensic
6%4% 4% 4% 5% 6%
0%
30%
2012 2013 2014 2015 2016 2017
Eastern State Hospital – Forensic
HOMELESS WITHIN 6 MONTHS
15%13%
17%14%
16% 15%
0%
30%
2012 2013 2014 2015 2016 2017
Western State Hospital – Forensic
10% 9%6% 7% 7%
11%
0%
30%
2012 2013 2014 2015 2016 2017
Eastern State Hospital – Forensic
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, May 2018.
69 of 654 49 of 608 84 of 672 66 of 683 85 of 742 103 of 943
10 of 155 6 of 159 5 of 119 5 of 138 9 of 197 16 of 265
100 of 654 82 of 608 115 of 672 94 of 683 122 of 742 145 of 943
15 of 155 14 of 159 7 of 119 10 of 138 13 of 197 28 of 265
STATUSUPDATED MAY 2018
NOTE: Patients admitted as Not Guilty by Reason of Insanity and for Competency Restoration are excluded from homeless counts. Homelessness defined as client being Homeless w/o Housing, client living in a Emergency Housing Shelter or in a Battered Spouse Shelter.
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 41
Civil Discharges with Homelessness Following ExitPercent by final facility in an episode and State Fiscal Year| Narrow Definition of Homelessness, Non-adjusted
3% 2% 3% 4%2% 1%
0%
30%
2012 2013 2014 2015 2016 2017
Western State Hospital – Civil
2% 2% 2% 2% 3% 4%
0%
30%
2012 2013 2014 2015 2016 2017
Eastern State Hospital – Civil
5% 4%6% 6%
4% 3%
0%
30%
2012 2013 2014 2015 2016 2017
Western State Hospital – Civil
3% 4% 3% 4% 4%7%
0%
30%
2012 2013 2014 2015 2016 2017
Eastern State Hospital – Civil
16 of 484 13 of 546 15 of 459 18 of 459 6 of 366 3 of 348
11 of 599 12 of 516 11 of 548 10 of 478 13 of 458 14 of 319
24 of 484 21 of 546 27 of 459 26 of 459 14 of 366 12 of 348
18 of 599 19 of 516 18 of 548 17 of 478 18 of 458 21 of 319
HOMELESS WITHIN 1 MONTH HOMELESS WITHIN 6 MONTHS
STATUSUPDATED MAY 2018
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, May 2018.
NOTE: Homelessness defined as client being Homeless w/o Housing, client living in a Emergency Housing Shelter or in a Battered Spouse Shelter.
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 42
Community Hospital and E&T Discharges with Homelessness Following Exit Percent by final facility in an episode and State Fiscal Year| Narrow Definition of Homelessness, Non-adjusted
10% 10% 10%12% 11% 11%
0%
30%
2012 2013 2014 2015 2016 2017
Community Hospitals
10% 11% 9%7%
11% 11%
0%
30%
2012 2013 2014 2015 2016 2017
Evaluation & Treatment Centers
13% 12% 13%15% 14% 14%
0%
30%
2012 2013 2014 2015 2016 2017
Community Hospitals
13% 14%12%
10%13% 13%
0%
30%
2012 2013 2014 2015 2016 2017
Evaluation & Treatment Centers
617 of 6,407 648 of 6,543 665 of 6,545 902 of 7,493 932 of 8,569 1,124 of 10,172
252 of 2,479 356 of 3,305 308 of 3,360 259 of 3,682 423 of 4,020 431 of 3,913
807 of 6,407 798 of 6,543 834 of 6,545 1,105 of 7,493 1,169 of 8,569 1,441 of 10,172
331 of 2,479 457 of 3,305 390 of 3,360 352 of 3,682 513 of 4,020 528 of 3,913
HOMELESS WITHIN 1 MONTH HOMELESS WITHIN 6 MONTHS
STATUSUPDATED MAY 2018
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, May 2018.
NOTE: Homelessness defined as client being Homeless w/o Housing, client living in a Emergency Housing Shelter or in a Battered Spouse Shelter.
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 43
Behavioral Health (Substance Use Disorder Treatment, Outpatient MH)PART 4d
DATA NOTES: • BHA SUD data for FY2016 is incomplete across all treatment modalities and all BHO/FIMC regions beginning April 1, 2016, with the exception of North Central BHO.
SUD outcomes for 2016 are likely to increase from the currently reported values.• Admission to publicly funded residential, outpatient, or medication assisted substance use disorder treatment, does not include services delivered through the
Department of Corrections. Self-help group activities such as Alcoholics Anonymous are not funded by or reported to BHA. • SUD treatment need determined through HCA medical and pharmacy claims, WSP arrest indicators, and BHA treatment records. • Mental Health community outpatient services include all BHA-funded treatment modalities (excludes crisis , ITA, and support activities).
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 44
Discharges with Substance Use Disorder (SUD) Treatment Following ExitPercent by final facility in an episode and State Fiscal Year | Of those with SUD treatment need indicator only
IN SUD TREATMENT WITHIN 3 MONTHS
23% 25% 19%13% 18% 17%
0%
100%
2012 2013 2014 2015 2016 2017
Western State Hospital – Forensic
23% 23% 25% 21%10%
18%
0%
100%
2012 2013 2014 2015 2016 2017
Eastern State Hospital – Forensic
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, May 2018.
22 of 95 24 of 95 19 of 102 19 of 148 32 of 178 31 of 178
5 of 22 5 of 22 3 of 12 5 of 24 4 of 40 16 of 91
STATUSUPDATED MAY 2018
NOTE: Admission to publicly funded residential, outpatient, or medication assisted substance use disorder treatment, does not include services delivered through the Department of Corrections. SUD treatment need determined through HCA medical and pharmacy claims, WSP arrest indicators, and BHA treatment records.
IN SUD TREATMENT WITHIN 3 MONTHS
25% 23%14% 16% 18% 22%
0%
100%
2012 2013 2014 2015 2016 2017
Western State Hospital – Civil
49%40% 40% 37%
26%19%
0%
100%
2012 2013 2014 2015 2016 2017
Eastern State Hospital – Civil
23 of 92 24 of 105 15 of 107 17 of 107 17 of 92 19 of 85
83 of 171 53 of 132 61 of 152 60 of 163 40 of 156 24 of 126
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 45
Community Hospital and E&T Discharges with SUD Treatment Following ExitPercent by final facility in an episode and State Fiscal Year | Of those with SUD treatment need indicator only
IN SUD TREATMENT WITHIN 3 MONTHS
23% 22% 22% 19% 19% 23%
0%
100%
2012 2013 2014 2015 2016 2017
Community Hospitals
30% 30% 26%
12% 13%24%
0%
100%
2012 2013 2014 2015 2016 2017
Evaluation & Treatment Centers
955 of 4,092 918 of 4,220 898 of 4,173 933 of 4,999 1,034 of 5,416 1,393 of 6,179
268 of 900 383 of 1,287 347 of 1,313 298 of 2,535 338 of 2,531 416 of 1,727
NOTE: Admission to publicly funded residential, outpatient, or medication assisted substance use disorder treatment, does not include services delivered through the Department of Corrections. SUD treatment need determined through HCA medical and pharmacy claims, WSP arrest indicators, and BHA treatment records.
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, May 2018.
STATUSUPDATED MAY 2018
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 46
Forensic Discharges with Outpatient Mental Health Visit Following ExitPercent by final facility in an episode and State Fiscal Year | Based on those with Title XIX eligibility only
OUTPATIENT MH SERVICE WITHIN 7 DAYS
41% 44% 48%38%
30% 33%
0%
100%
2012 2013 2014 2015 2016 2017
Western State Hospital – Forensic
70%76%
63%49%
58%69%
0%
100%
2012 2013 2014 2015 2016 2017
Eastern State Hospital – Forensic
OUTPATIENT MH SERVICE WITHIN 30 DAYS
59% 61% 59% 57%46% 51%
0%
100%
2012 2013 2014 2015 2016 2017
Western State Hospital – Forensic
81% 84%78%
61%74%
81%
0%
100%
2012 2013 2014 2015 2016 2017
Eastern State Hospital – Forensic
56 of 135 69 of 156 82 of 171 90 of 239 95 of 317 118 of 357
30 of 43 28 of 37 25 of 40 24 of 49 40 of 69 72 of 105
80 of 135 95 of 156 101 of 171 136 of 239 147 of 317 181 of 357
35 of 43 31 of 37 31 of 40 30 of 49 51 of 69 85 of 105
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, May 2018.
STATUSUPDATED MAY 2018
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 47
Civil Discharges with Outpatient Mental Health Visit Following ExitPercent by final facility in an episode and State Fiscal Year | Based on those with Title XIX eligibility only
82% 78%84% 79% 76%
69%
0%
100%
2012 2013 2014 2015 2016 2017
Western State Hospital – Civil
90%79% 81% 85% 89% 89%
0%
100%
2012 2013 2014 2015 2016 2017
Eastern State Hospital – Civil
90% 87% 90% 85% 81% 78%
0%
100%
2012 2013 2014 2015 2016 2017
Western State Hospital – Civil
96%88% 92% 95% 95% 97%
0%
100%
2012 2013 2014 2015 2016 2017
Eastern State Hospital – Civil
142 of 174 136 of 175 147 of 174 157 of 198 122 of 160 90 of 130
207 of 229 157 of 198 167 of 207 183 of 215 179 of 201 127 of 142
157 of 174 152 of 175 157 of 174 168 of 198 130 of 160 101 of 130
219 of 229 174 of 198 190 of 207 204 of 215 190 of 201 138 of 142
OUTPATIENT MH SERVICE WITHIN 7 DAYS OUTPATIENT MH SERVICE WITHIN 30 DAYS
STATUSUPDATED MAY 2018
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, May 2018.
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DSHS | Facilities, Finance, and Analytics Administration | Research and Data Analysis Division ● OCTOBER 2018 48
Community Hospital and E&T Discharges with Outpatient MH Visit Following Exit Percent by final facility in an episode and State Fiscal Year | Based on those with Title XIX eligibility only
58% 60% 61% 62% 59% 59%
0%
100%
2012 2013 2014 2015 2016 2017
Community Hospital
71% 73% 78% 82% 78% 74%
0%
100%
2012 2013 2014 2015 2016 2017
Evaluation & Treatment
68% 70% 72% 74% 72% 72%
0%
100%
2012 2013 2014 2015 2016 2017
Community Hospital
81% 84% 87% 90% 87% 85%
0%
100%
2012 2013 2014 2015 2016 2017
Evaluation & Treatment
1,923 of 3,304 1,981 of 3,296 2,361 of 3,852 3,138 of 5,079 3,177 of 5,387 3,735 of 6,305
719 of 1,018 982 of 1,353 1,177 of 1,515 1,646 of 2,017 1,728 of 2,222 1,575 of 2,116
2,237 of 3,304 2,310 of 3,296 2,792 of 3,852 3,770 of 5,079 3,874 of 5,387 4,570 of 6,305
828 of 1,018 1,133 of 1,353 1,312 of 1,515 1,817 of 2,017 1,923 of 2,222 1,805 of 2,116
OUTPATIENT MH SERVICE WITHIN 7 DAYS OUTPATIENT MH SERVICE WITHIN 30 DAYS
UPDATED MAY 2018
SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases, May 2018.